Embedded Psychiatric Services in a Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Assessment of Patient Needs and Perceptions

Objective: Amyotrophic lateral sclerosis (ALS) is often associated with a range of difficult neuropsychiatric symptoms and conditions, including depression, apa-thy, pseudobulbar affect, and frontotemporal demen-tia (FTD). Despite the potential role for psychiatrists in the treatment of ALS, they are not typically involved in the ALS clinical team. The investigators describe a quality improvement intervention providing embedded psychiatric services within a multidisciplinary clinic (MDC). Methods: A psychiatrist working within an ALS MDC eval-uated patients (N5116) over a 1-year period. The clinic assessed the prevalence of neuropsychiatric symptoms and conditions in patients with ALS (depression, anxiety, pseudobulbar affect, and cognitive impairment, including FTD) using standardized screening methods. Fifty-five patients and 47 family members completed surveys about perceptions of their need for psychiatric care, their experi-ence of meeting with a psychiatrist, and their desire for future access to psychiatric care. Results: Prevalence rates for neuropsychiatric symptoms were 14.9% for depression, 11.3% for anxiety, 19% for cog-nitive impairment (including FTD, 8.6%), and 36.2% for pseudobulbar affect; 62.0% of patients were being pre-scribed at least one psychotropic medication. Both patients and family members reported that meeting with a psychiatrist was helpful, that the treatment provided was helpful, and that they would prefer continued availability of psychiatric services in the future. The presence of cog-nitive impairment and use of antidepressants increased the likelihood of patients reporting a benefit from psychi-atric care. Conclusions: Patients with ALS report a benefit from increased access to psychiatric services. The inclusion of psychiatrist within the ALS MDC model should be con-sidered to improve quality of care for this patient population.